Psychological First Aid Kathy Berlin RN MRC Coordinator

Psychological First Aid Kathy Berlin, RN MRC Coordinator Elizabeth Mc. Clure, MD, MPH Medical Director Academic Health Center Office of Emergency Response

Training Objectives n n Understand key points of Psychological First Aid (PFA) Increase awareness of the signs and symptoms of stress Identify strategies to limit distress and negative health behaviors Identify strategies to support resilience among responders

Psychological First Aid Key Points n n Parallel to medical first aid Uses skills you probably already have Designed for use in the immediate aftermath of a disaster Offers practical assistance & information

Psychological First Aid Key Points n Appropriate for all ages n Culturally informed n Consistent with research evidence on risk and resilience following trauma

Psychological First Aid: Who, Where, When? n Who delivers PFA? – n Where is PFA used? – n First responder teams, Medical Reserve Corps (MRC), Community Emergency Response Teams (CERT) and others Family assistance centers, mass triage facilities , mass dispensing sites, special needs shelters When is PFA used? – As an integral part of the immediate disaster response

Endorsed by…… n n n American Psychological Association WHO, CDC, MDH National Institute for Mental Health National Center for PTSD Metro Disaster Behavioral Health Work Group SAMHSA

Psychosocial Consequences of Disasters Fear and Distress Response Impact of Disaster Event Behavior Change Psychiatric Illness Source: Butler AS, Panzer AM, Goldfrank LR, Institute of Medicine Committee on Responding to the Psychological Consequences of Terrorism Board of on Neuroscience and Behavioral Health. Preparing for the psychological consequences of terrorism: A public health approach. Washington, D. C. : National Academies Press, 2003.

Reactions to Stress Adults n n n Physical Behavioral Emotional Cognitive Spiritual

Reactions to Stress Children n n Physical Behavioral Emotional Cognitive Spiritual

Events are More Stressful or Traumatic When…… n n n Event is unexpected Many people die, especially children Event lasts a long time The cause is unknown The event is poignant or meaningful Event impacts a large area

Minimize negative emotional impact of a disaster through…. . n Rapid intervention n Identification, labeling, and expression of emotions n Regaining a sense of mastery and control over life

PFA Big Picture: Target Outcomes n n n Restore Safety – Safeguard – Sustain through basic needs Facilitate Function – Comfort – Connect Empower Action – Education – Resilience

Psychological First Aid Help Card n Goal: – Promote Safety – Calm and Comfort – Connectedness – Self-empowerment

Psychological First Aid Help Card n Responder Resilience – Prevention Strategies – Self care n When in Doubt- CONSULT!

PROMOTE SAFETY n n Safeguarding survivors and sustaining their basic needs n n n Meet basic survival needs Offer practical assistance and information Shield survivors from onlookers/ media Repeat information as often as needed Assist in finding resources

CALM AND COMFORT n n n Facilitate psychological function through calming and connection n Compassionate presence Active listening Don’t push for information Use stress management techniques Be flexible and supportive Comfort, console, soothe

What People Need n n To talk to about their experience Someone to care Someone to really listen Someone to lean on or cry with

Active Listening § § Body language § eye contact § facial expression § tone of voice Gentle prompts Label, summarize, and mirror Compassionate presence

Active Understanding n n n Try not to interrupt until story ended Do ask questions to clarify Occasionally restate part of the story in your own words to make sure you understand

Active Understanding n n n Avoid Why/Why not? Don’t judge Avoid “I know how you feel. ” Avoid evaluation of their experience and their reactions Silence is O. K.

It is NOT OK to say…. n n n n Let’s talk about something else You should work toward getting over this You are strong enough to deal with this You’ll feel better soon You did everything you could You need to relax It’s good that you are alive

Stress reactions are normal n Basic information on ways of coping n Psychological reactions are common and expected n Simple relaxation techniques

Agitation § § § Refusal to follow directions Loss of control, becoming verbally agitated Becoming threatening It is not personal This is their reaction to an UNCOMMON situation, it has nothing to do with you

When to Refer n n n n Harm to self or others Inability to make simple decisions Significant withdrawal Ritualistic behavior Hallucinations/paranoia Disorientation to time and place Unable to care for self

How to Refer n n Ask about reaction to referral Make referral with individual present Don’t push referral unless person appears to be at imminent risk to self or others Cold referrals are generally not successful

CONNECTEDNESS n n Facilitate psychological function through calming and connection n n Help connect with friends and loved ones Keep survivor families intact Reunite children with family Connect survivors to available support services

SELF EMPOWERMENT n n Reestablish hope and action through education and empowerment n n Clarify Disaster information Engage towards meeting own needs Work toward “normal” life activities Guide towards what to expect, teach resilience

Resiliency Ability to accommodate and bounce back after a setback disappointment crisis or major distress.

Promote Resiliency n n Everyone who experiences a disaster is touched by it We have the ability to bounce back after a disaster to a new normal Resilience can be fostered One goal of PFA: support resilience in ourselves and others

Personal Resiliency Plan n n Know your unique stressors and red flags Know unique stressors of the event: extent of damage, death, and current suffering Monitor on-going internal stress Emotional pain and anxiety are contagious

Responder Resiliency Tools n Help Card – Prevention Strategies – Self Care n Resiliency – Pre-event – During event – Post-event

Building Responder Resilience Pre-event § Educate and train § Build social support systems § Instill sense of mission & purpose § Create family communications plan § Learn coping strategies

Building Responder Resilience During event n n n If possible, use the buddy system Focus on immediate tasks at hand Monitor health, safety, and psychological well-being Know your limits Activate family communications plan

Compassion Fatigue There is a cost to caring. We professionals who are paid to listen to the stories of fear, pain, and suffering of others may feel, ourselves, similar fear, pain and suffering because we care. Compassion fatigue is the emotional residue of exposure to working with the suffering, particularly those suffering from the consequences of traumatic events. Charles R. Figley, Ph. D. 37

Building Responder Resilience Post-event n n Delayed reactions seen among general public and emergency responders Monitor health and well-being Take time to recover Seek support when needed

Self Care Post-event § § Expect a reintegration period upon returning to your usual routine. Pay attention to cues from your family that you are becoming too involved.

GROUP PARTICIPATION

Q: Effective communication during times of trauma may include repeating information often. Q: Which of the following describes possible symptoms of stress in children? a. Fear of being alone b. Difficulty sleeping c. Sense of guilt or responsibility for event d. Regression e. All of the above

Q: Physical symptoms of stress, such as elevated heart rate & breathing can sometimes improve with calm, soothing verbal intervention. Q: Children may feel more secure in a structured environment (such as school) after a traumatic event.

Q: During a traumatic event, it is helpful to provide immediate psychotherapy. Q: During the crisis response, it is important to do which of the following? a. Work in partners or teams b. Take brief stress breaks c. Check in with others d. Talk about your feelings at the end of the day e. All of the above

Q: There is an adjustment period after returning from a crisis. True or False

Learn More • On-line Courses: – “Psychological Issues Following a Disaster”, U of M Center for Public Health Preparedness • – Mental Health Consequences of Disasters”, Johns Hopkins Center for Public Health Preparedness • • http: //cpheo. sph. edu (I ½ hours) http: //nccphp. sph. unc. edu/training (I hour) Other Resources – – DEEP PREP “All Hazards Disaster Behavioral Health Training” SAMHSA Website • – http: //mentalhealth. samhsa. gov/publications/Publications_browse. a sp? ID=181&Topic=Disaster%2 f. Trauma American Academy of Child and Adolescent Psychiatry Website • http: //mentalhealth. samhsa. gov/_scripts/redirect. asp? ID=775